Hypothesis: Total pancreatectomy for infiltrating ductal adenocarcinoma is not superior to pancreaticoduodenectomy or distal pancreatectomy.
Design: A retrospective analysis of a prospective database of patients.
Setting: Memorial Sloan-Kettering Cancer Center, New York, NY.
Patients: All patients (n = 488) undergoing pancreatic resection.
Main outcome measures: Duration of operation, estimated blood loss, complications, length of stay, number of positive lymph nodes, presence of a positive margin, and survival times were analyzed.
Results: Thirty-five patients were identified who underwent total pancreatectomy, 28 of whom had adenocarcinoma. Median length of stay was 32 days; 19 (54%) developed postoperative complications, of which 63% were infectious. Thirty-day mortality was 3% (1 patient). Median survival was 9.3 months (range, 0.6-172 months). There was no significant difference between patients with and without adenocarcinoma in terms of duration of operation, estimated blood loss, complications, length of stay, or number of readmissions. In patients with adenocarcinoma, margin or nodal status were not significant survival variables. Patients undergoing total pancreatectomy for adenocarcinoma had a significantly worse overall survival than those undergoing total pancreatectomy for other reasons (P<.001), or compared with a contemporaneous cohort with adenocarcinoma undergoing pancreaticoduodenectomy (n = 409) and distal pancreatectomy (n = 51) (7.9 vs 17.2 months; P<.002).
Conclusions: Total pancreatectomy can be performed safely with low mortality; survival is predicted by the underlying pathologic findings: patients undergoing total pancreatectomy for adenocarcinoma have a uniformly poor outcome. Those undergoing total pancreatectomy for benign disease or nonadenocarcinoma variants can have long-term survival. In patients who require total pancreatectomy for ductal adenocarcinoma, the survival is so poor as to bring into question the value of the operation.